Program Forms

REMINDER: As per USDA, the Program Forms should be distributed on or about the beginning of the school year. *Forms cannot be distributed before July 1.

Operational Forms

Form Name Format
Requesting Common Logon Permissions for NSLP/Direct Certification PDF
Health and Nutrition Services Entity Data Form (ADD/CHANGE/DELETE) PDF
Food Program Permanent Service Agreement (2 originals must be submitted for ADE approval) PDF
Free and Reduced Price Policy Statement-New Word
If applicable to your operation, please also include:
  • Addendum- Provision 2
Word
  • Addendum- Provision 3
Word
  • Addendum- Community Eligibility Provision
Word
  • Addendum- Non-Pricing
Word

ALL FORMS UPDATED FOR SY 2015-2016

Requesting Eligibility Information

Form Name Format
Reimbursement Rates– NEW PDF
Media/Press Release PDF Word
Requesting Common Logon Permissions for NSLP/Direct Certification PDF
Application for free and reduced-price meals (English) PDF Word
Application for free and reduced-price meals (Spanish) –Now Available  PDF Word
Instructions for free and reduced-price meal application (English) PDF Word
Instructions for free and reduced-price meal application (Spanish) –Now Available   PDF Word
Parent Letter (English) PDF Word
Parent Letter (Spanish)-Now Available  PDF Word
Foster Outreach Letter – USDA Sample Template PDF Word
Special Milk Letter, pricing, No applications (English) PDF Word
Special Milk Letter, pricing, No applications (Spanish) PDF Word
Special Milk, Letter to Parents, Applications (English) PDF Word
Special Milk, Letter to Parents, Applications (Spanish) PDF Word
Civil Rights Compliance PDF Word
Non-Disabled Student Special Diet Order Form PDF Word
Disabled Student Special Diet Order Form PDF Word
Memorandum of Understanding PDF Word
Parent/Guardian Disclosure Consent
PDF Word

 

Certifying Income Eligible Children

Form Name Format
Income Guidelines PDF
Notification of Benefits Letter, School Meals (English) PDF Word
Notification of Benefits Letter, School Meals (Spanish)-Coming Soon PDF Word
Notification letter, Milk, Pricing (English) PDF Word
Notification letter, Milk, Pricing (Spanish) PDF Word
Notification for Free School Meals Letter, Direct Certification (English) PDF Word
Notification for Free School Meals Letter, Direct Certification (Spanish) PDF Word

 

Verifying Household Applications

Form Name Format
Notification of Verification Letter, School Meals (English) PDF Word
Notification of Verification Letter, School Meals (Spanish) PDF Word
Letter of Verification Results (English) PDF Word
Letter of Verification Results (Spanish) PDF Word
Error-Prone Worksheet PDF
Verification Tracking Form PDF
Verification for Cause Tracking Form PDF

 

Additional Program Forms

Form Name Format
After School Snack Program Site Review Form PDF Word
Summary of Meals Served Worksheet PDF Word
Active Excel Daily Edit Check Worksheet XLS
Daily Edit Check Worksheet PDF Word
Updated On-Site Review Checklist PDF Word
Parent Letter of Non-Base Year PDF Word
Parent Letter of Non-Base Year – Spanish PDF Word
USDA Civil Rights Posters PDF
Paid Lunch Equity (PLE):  SY 2015-2016 Calculations and Tool XLS

 

Meal Pattern Related Forms

Form Name Format Format
Production Record (with menu contributions) PDF Word
Production Record (no menu contributions) PDF Word
Production Record for Multiple Grades PDF Word
Afterschool Snack Program Production Record PDF Word

For household materials in more languages:
http://www.fns.usda.gov/cnd/Application/translatedapps.html